Medicare in Ohio

November 3, 2014

Medicare beneficiaries living in Ohio have more coverage options than just the federally funded benefits offered by Original Medicare, Part A and Part B. There are private versions of this insurance, called Medicare Advantage, or Medicare Part C, that must provide all of the same coverage but can include additional benefits as well. Other private insurance plans, like Medicare Part D prescription drug coverage and Medicare Supplement insurance, can be added to existing Part A and Part B coverage to provide additional benefits.

Unlike Medicare Part A and Part B, the availability of these private Medicare insurance plans may vary depending on your zip code.

Original Medicare for Ohio beneficiaries

Original Medicare is another name for Medicare Part A and Part B. It is the health insurance program created and administered by the federal government for U.S. citizens aged 65 and older, and for younger people with certain qualifying disabilities. Part A covers inpatient hospital care and Part B covers doctor visits, preventative services, and durable medical equipment. Original Medicare doesn't cover prescription drugs.

Original Medicare is available to eligible beneficiaries in any state in the country and the U.S. territories. Many beneficiaries in Ohio are enrolled automatically at the age of 65, provided they already receive retirement benefits through either the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). Some people can join Medicare well before age 65, provided they receive SSA disability benefits, or certain RRB disability benefits, for 24 consecutive months.

In these cases, the red, white, and blue Medicare membership card is mailed out to you approximately three months before your coverage begins, along with a "Welcome to Medicare" packet that contains educational information concerning the program.

Beneficiaries in Ohio who are not enrolled automatically can apply for Medicare during the Initial Enrollment Period (IEP), a period that begins three months before you turn 65, includes the month you turn 65, and goes for three additional months (for a total of seven months). It's usually best to sign up during the IEP. If you don't, you can enroll during the General Enrollment Period (January 1 - March 31 annually), but you could have to pay late enrollment penalties.

If you're still working at the age of 65 and covered under an employer's or union's health plan (or a spouse's plan), you can delay enrolling in Medicare Part B. Before the employer or union coverage ends, you can sign up for Part B during a Special Enrollment Period without a penalty.

To sign up for Medicare, you can go to your local SSA office or register online. You can also enroll over the phone:

Call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. Representatives are available Monday through Friday, from 7AM to 7PM.

If you worked for a railroad, call the RRB at 1-877-772-5772. TTY users can call 1-312-751-4701. Representatives are available Monday through Friday, from 9AM to 3:30PM.

Medicare private insurance in Ohio

There are other Medicare options in Ohio besides Original Medicare. The best time to sign up for these plans is usually during your Initial Enrollment Period (see above).

Medicare Part C, more commonly known as Medicare Advantage, is a plan offered by a private insurance company that contracts with Medicare to offer Part A and Part B benefits to those who enroll in it. While these plans must provide at least the same amount of coverage as Original Medicare (excluding hospice care, which remains covered through Medicare Part A), Part C plans may include other benefits, such as vision, hearing, dental, and even prescription drug coverage. You still continue to pay your Medicare Part B premium when you're enrolled in a Medicare Advantage program.

Not every Medicare Advantage plan has prescription drug coverage, but the ones that do are referred to as Medicare Advantage Prescription Drug plans (sometimes abbreviated as MA-PDs). These plans provide all of your Medicare coverage as one plan.

You can also sign up for a Medicare Advantage Plan during the Annual Election Period (from October 15 to December 7).

Medicare Supplement plans, more commonly known as Medigap plans, are available to beneficiaries in Ohio who are enrolled in Medicare Part A and Part B and are looking to cover those out-of-pocket costs. Private insurers can offer up to 10 standardized policy options, each one named with a letter. Plans of the same letter offer the same benefits no matter which insurance company offers the plan. At the very least, a Medicare Supplement insurance company must offer Plan A. If it sells other Medigap, it must also offer Plan C or Plan F.

Medicare Part D is a stand-alone benefit offering prescription drug coverage. To get this benefit, you must have Medicare Part A and/or Medicare Part B.

Each plan has a formulary, which is a list of prescription medications covered by that plan. Formulary details are likely to vary by plan, as will pricing. Before joining a Part D plan, we recommend that you compare all available plans in your area to find one that best suits your needs.

If you'd like to sign up for Medicare prescription drug plan, the best time to do so is usually during your IEP. You can also sign up during the Annual Election Period (from October 15 to December 7), but if you don't sign up when you're first eligible, you could pay a late-enrollment penalty.

Ohio resources for Medicare beneficiaries

There are numerous resources at your disposal when looking at Medicare in Ohio, according to Medicare.gov. Many of these are established to assist you with any Medicare questions you might have, as well as providing answers to additional questions you may have.